Epidural brain abscess
Epidural brain abscess (external pachymeningitis) - the least dangerous intracranial complications, but at the same time, he may be the intermediary in the development of other more serious complications. Epidural brain abscess occurs as acute otitis media that complicated with mastoiditis and exacerbation of chronic suppurative otitis media, especially if the latter is accompanied by cholesteatoma.
Most often this complication occurs in acute otitis. Epidural brain abscess is localized at the same time in the posterior fossa, in the vicinity of the sigmoid sinus (the so-called perisinus abscess) or less in the middle cranial fossa, in the roof of the tympanic cavity and mastoid caves. Much less common a deep localization of the epidural brain abscess at the front or rear surface of the petrous part of its leadership.
Epidural brain abscess is usually of limited length. Only very rarely seen widespread process involving both dura mater in the middle and posterior cranial depressions.
Symptoms and course of epidural brain abscess
Epidural brain abscess is usually asymptomatic or masked clinical mastoiditis or exacerbation of chronic otitis media. Sometimes still have symptoms suggestive of this disease. These include:
- sudden headache on the side of a patient ear, mainly at night
- pastiness, soreness and sometimes fluctuant on the falling edge of the mastoid
- plentiful pulsating pus in the late stage of acute otitis media or chronic suppurative otitis
The pain sometimes radiates into the forehead, eye socket, the teeth, which happens at a deep localized abscess in the apex of the pyramid. Suspicious for epidural brain abscess is increasing headache while reducing the purulent discharge from the ear and its decrease with increasing suppuration.
Rarely observed changes in the fundus (stagnant nipples optic nerves) that can be combined with inhibition, nausea or vomiting, and bradycardia. Thus there is an assumption on the formation of brain abscess, even more reasonable if joining focal symptoms are very rare in an uncomplicated epidural abscess.
Diagnosis of epidural brain abscess
Most often due to absence or low severity of symptoms epidural brain abscess is recognized during surgery on the ear. However, when a combination of strong, one-sided headache with plentiful pulsating suppuration of the ear and the presence of the above symptoms of the mastoid process, we can make the correct diagnosis and before surgery.
Magnetic resonance imaging (MRI) performed for suspected epidural abscess of the brain.
If the operation time is not made, then usually develop other, more serious intracranial complication - sigmoid sinus thrombosis and sepsis, purulent meningitis, subdural, or brain abscess. Successfully using auxiliary methods of diagnosis in the form:
- MRI of the brain
- MR angiography
- CT of the brain
- CT angiography
- based on data from the puncture of the brain
Treatment of epidural brain abscess
Operation on the ear with epidural brain abscess or routine craniotomy depending on the form of inflammation of the middle ear, the wide exposure of the dura mater posterior or middle cranial fossa. The shell is exposed within the healthy-looking tissue.
In the absence of septic phenomena nude sigmoid sinus puncture is not performed. When expressed meningeal phenomena of antibiotics prescribed by antibiotic sensitivity.